Quality of Opioid Use Disorder Treatment for Persons With and Without Disabling Conditions
Authors: Cindy Parks Thomas, Maureen T. Stewart, Emily Ledingham, Rachel Sayko Adams, Lee Panas, Sharon Reif
Journal: JAMA Network Open (2023)

Importance Adverse outcomes associated with opioid use disorder (OUD) are disproportionately high among people with disabilities (PWD) compared with those without disability. A gap remains in understanding the quality of OUD treatment for people with physical, sensory, cognitive, and developmental disabilities, specifically regarding medications for OUD (MOUD), a foundation of treatment. Objective To examine the use and quality of OUD treatment in adults with diagnosed disabling conditions, compared with adults without these diagnoses. Design, Setting, and Participants This case-control study used Washington State Medicaid data from 2016 to 2019 (for use) and 2017 to 2018 (for continuity). Data were obtained for outpatient, residential, and inpatient settings with Medicaid claims. Participants included Washington State full-benefit Medicaid enrollees aged 18 to 64 years, continuously eligible for 12 months, with OUD during the study years and not enrolled in Medicare. Data analysis was performed from January to September 2022. Exposures Disability status, including physical (spinal cord injury or mobility impairment), sensory (visual or hearing impairments), developmental (intellectual or developmental disability or autism), and cognitive (traumatic brain injury) disabilities. Main Outcomes and Measures The main outcomes were National Quality Forum–endorsed quality measures: (1) use of MOUD (buprenorphine, methadone, or naltrexone) during each study year and (2) 6-month continuity of treatment (for those taking MOUD). Results A total of 84 728 Washington Medicaid enrollees had claims evidence of OUD, representing 159 591 person-years (84 762 person-years [53.1%] for female participants, 116 145 person-years [72.8%] for non-Hispanic White participants, and 100 970 person-years [63.3%] for participants aged 18-39 years); 15.5% of the population (24 743 person-years) had evidence of a physical, sensory, developmental, or cognitive disability. PWD were 40% less likely than those without a disability to receive any MOUD (adjusted odds ratio [AOR], 0.60; 95% CI, 0.58-0.61; P &amp;amp;lt; .001). This was true for each disability type, with variations. Individuals with a developmental disability were least likely to use MOUD (AOR, 0.50; 95% CI, 0.46-0.55; P &amp;amp;lt; .001). Of those using MOUD, PWD were 13% less likely than people without disability to continue MOUD for 6 months (adjusted OR, 0.87; 95% CI, 0.82-0.93; P &amp;amp;lt; .001). Conclusions and Relevance In this case-control study of a Medicaid population, treatment differences were found between PWD and people without these disabilities; these differences cannot be explained clinically and highlight inequities in treatment. Policies and interventions to increase MOUD access are critical to reducing morbidity and mortality among PWD. Potential solutions include improved enforcement of the Americans with Disabilities Act, workforce best practice training, and addressing stigma, accessibility, and the need for accommodations to improve OUD treatment for PWD.